Background check authorization form
A stand-alone background check disclosure and authorization for job applicants, with the applicant details a screening company asks for.
- 🇺🇸 US format · Letter size
- Free
This is a sample form. Check that the terms and pay match federal and state labor rules and your company policy.
Fill in what you need. The preview updates as you type.
What you type is not saved on our server.
A general template, not legal advice
This is a general template, not legal advice. FCRA disclosure forms are a common target of class action suits, and California, New York, Washington, Minnesota and Oklahoma, among others, require their own notices. Ask your screening company for its state forms and have a lawyer check the final packet.
- Many states and cities have fair chance laws that limit when you may ask about or check criminal history, often only after a conditional offer.
- Do not add a release of liability or any other terms to the disclosure page. Courts have found that extra language breaks the stand-alone rule.
- Attach the current "A Summary of Your Rights Under the Fair Credit Reporting Act". Your screening company can supply it.
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Disclosure Regarding Background Investigation
Contoso Logistics LLC (the "Company") may obtain one or more consumer reports about you from a consumer reporting agency for employment purposes. Employment purposes include deciding whether to hire you.
A consumer report may include information about criminal history, verification of past employment, verification of education and degrees and driving records.
Authorization of background investigation
I have read the Disclosure Regarding Background Investigation and I have received a copy of "A Summary of Your Rights Under the Fair Credit Reporting Act." I authorize Contoso Logistics LLC to obtain consumer reports about me for employment purposes from Northwind Screening Services, Inc. (1200 Riverside Dr, Austin, TX 78741, (555) 010-0040, northwindscreening.example.com).
State notices. If you live in, or are applying for work in, one of these states, check it. The Company will give you that state's notice.
□ California □ New York □ Washington □ Minnesota □ Oklahoma
Applicant information
The consumer reporting agency uses this information only to identify you and find your records. The Company does not use your date of birth to make hiring decisions.
| Full legal name | Casey Nguyen | ||
|---|---|---|---|
| Other names used | |||
| Date of birth | Social Security number | ||
| Driver's license number | State | ||
| Current address | |||
| Previous addresses | |||
| Phone | |||
| Position applied for | Delivery Driver | ||
Applicant signature: ______________________ Date: ____________
Attachment: A Summary of Your Rights Under the Fair Credit Reporting Act (a copy for the applicant to keep).
How to use it
Type the employer and the screening company, check what the report may cover, and choose whether the permission is for this application only or for the whole employment. The applicant name and position are optional; leave them empty to print blank copies. The disclosure prints first with nothing else on it. The second page holds the authorization, a state notice check line, the applicant information box and the signature.
Print the disclosure and the authorization as two pages and give them to the applicant together with "A Summary of Your Rights Under the Fair Credit Reporting Act". Keep the signed authorization in the hiring file, separate from the personnel file.
Things to watch
The Fair Credit Reporting Act says the disclosure must be in a document that consists solely of the disclosure, and the FTC says it cannot be part of the job application. Do not add waivers or other terms to it. If you might reject the applicant because of the report, you must first give them a copy of the report and the summary of rights so they can dispute errors.
Calculators that go with this
Frequently asked questions
Why are the disclosure and the authorization separate?
The FCRA requires the disclosure to be in a document that consists solely of the disclosure. The authorization may be on the same document, but many employers print it on its own page to stay clear of claims that extra text crowded the disclosure. This form puts everything else on the second page.
What is "A Summary of Your Rights Under the FCRA"?
A standard notice written by the federal government that explains what consumer reports are and how to dispute errors. Your screening company should give you the current version. Hand it to the applicant with this form, and again with a copy of the report before any adverse action.
Do I need the applicant's Social Security number?
The screening company usually asks for it to match records. Collect it only on this form, keep it locked away from the hiring decision, and shred it when you no longer need it. Do not use date of birth in the hiring decision.
Is what I type saved anywhere?
No. Everything stays in your browser and nothing is sent to our server. If you refresh the page it is gone, so print, save a PDF or download the DOCX when you are done.